The effects of COVID-19 on cognitive performance in a community-based cohort: a COVID symptom study biobank prospective cohort study

Cheetham, Nathan J.; Giunchiglia, Valentina; Bowyer, Vicky; Sudre, Carole H.; Canas, Liane S; Deng, Jie; Murray, Benjamin; Kerfoot, Eric; Antonelli, Michela; Rjoob, Khaled; Molteni, Erika; Österdahl, Marc F.; Harvey, Nicholas R.; Trender, William; Malim, Michael H.; Doores, Katie J.; Hellyer, Peter J.; Modat, Marc; Hammers, Alexander; Ourselin, Sébastien; Duncan, Emma L.; Hampshire, Adam; Steves, Claire J.

doi:10.1016/j.eclinm.2023.102086

Cited by 42 publications

(41 citation statements)

References 46 publications

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“…Specific variants of SARS-CoV-2 may be an important risk factor on cognitive slowing, as self-reported PCC symptoms are more common in the earlier waves before the Omicron variant. 3,34 Thus, longitudinal studies with computerised speed tests in both PCC patients and those without PCC are needed to further confirm the group difference in relationship with time since infection.…”

Section: Discussionmentioning

confidence: 99%

Long COVID is associated with severe cognitive slowing

Zhao,

Martin,

Reuken

et al. 2023

Preprint

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BackgroundCOVID-19 survivors may suffer from a wide range of chronic cognitive symptoms for months or years as part of post-COVID-19 conditions (PCC). To date, there is no definitive objective cognitive marker for PCC. We hypothesised that a key common deficit in people with PCC might be generalised cognitive slowing.MethodsTo examine cognitive slowing, PCC patients completed two short web-based cognitive tasks, Simple Reaction Time (SRT) and Number Vigilance Test (NVT). 270 patients diagnosed with PCC at two different clinics in UK and Germany were compared to two control groups: individuals who contracted COVID-19 before but did not experience PCC after recovery (No-PCC group) and uninfected individuals (No-COVID group).FindingsWe identified pronounced cognitive slowing in PCC patients, which distinguished them from age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest PCC. Cognitive slowing was evident even on a 30-second task measuring simple reaction time (SRT), with PCC patients responding to stimuli ∼3 standard deviations slower than healthy controls. This finding was replicated across two clinic samples in Germany and the UK. Comorbidities such as fatigue, depression, anxiety, sleep disturbance, and post-traumatic stress disorder did not account for the extent of cognitive slowing in PCC patients. Furthermore, cognitive slowing on the SRT was highly correlated with the poor performance of PCC patients on the NVT measure of sustained attention.InterpretationTogether, these results robustly demonstrate pronounced cognitive slowing in people with PCC, which distinguishes them from age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest PCC. This might be an important factor contributing to some of the cognitive impairments reported in PCC patients.FundingWellcome Trust (206330/Z/17/Z), NIHR Oxford Health Biomedical Research Centre, the Thüringer Aufbaubank (2021 FGI 0060), German Forschungsgemeinschaft (DFG, FI 1424/2-1) and the Horizon 2020 Framework Programme of the European Union (ITN SmartAge, H2020-MSCA-ITN-2019-859890).Research in contextEvidence before this studyWe searched Google Scholar and PubMed for original research or review articles about the cognitive impairment after COVID-19, published up to 3 December 2023. We used terms relating to COVID-19 (SARS-CoV-2, influenza), post-acute symptoms (long COVID, post-COVID conditions, Post-Acute COVID Syndrome) and cognitive impairment (brain fog, cognitive deficit). Previous studies have shown that some people who recovered from the acute symptoms of COVID-19 might nevertheless experience deficits across an array of cognitive functions, including sustained attention, cognitive flexibility, and memory. However, most reports lacked consensus on the precise definition of post-COVID conditions and a common cognitive signature of post-COVID conditions remains unknown.Added value of this studyIn this investigation, we identified moderate to severe cognitive slowing in most patients with PCC, but not in most people who previously suffered COVID without developing PCC. This was replicated across two post-COVID clinics in Germany and the UK. To our knowledge, this is the first robust demonstration of cognitive slowing as a cognitive signature of post-COVID conditions.Implications of all the available evidenceUsing a 30-second web-based, self-administered psychomotor task, cognitive slowing in PCC can be reliably and easily measured as part of diagnostic work-up, and has potential to be a biomarker to track the progress of rehabilitation of PCC. To encourage researchers and clinicians to employ this task, we have ensured that it is available online with online feedback and all of our code is publicly accessible.

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Section: Discussionmentioning

confidence: 99%

Long COVID is associated with severe cognitive slowing

Zhao,

Martin,

Reuken

et al. 2023

Preprint

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“…A study at the beginning of the pandemic suggested that COVID‐19 infection may worsen neuropsychiatric symptoms in older adults with or without dementia 21 . These suggestions are supported by current literature reporting that COVID‐19 infections can have long‐term detrimental effects on cognitive function 22,23 …”

Section: Introductionmentioning

confidence: 86%

“…21 These suggestions are supported by current literature reporting that COVID-19 infections can have long-term detrimental effects on cognitive function. 22,23 Therefore, more information is required on the effects of the COVID-19 pandemic on the development of dementia and progression of cognitive decline. New evidence will allow for a better understanding of the impact of the COVID-19 pandemic on cognitive decline and ultimately can be used to aid prevention.…”

Section: Introductionmentioning

confidence: 99%

The risk of developing dementia in the COVID‐19 pandemic; a cohort study

Baron,

Coulthard,

David

et al. 2024

Int J Geriat Psychiatry

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ObjectivesThe effects of the COVID‐19 pandemic on cognitive decline are not fully understood. Higher social activity and relationships have been associated with decreased risk of dementia. We hypothesised that risk of transition to dementia would increase after the start of the first national lockdown.MethodsWe obtained data from the Brains for Dementia (BDR) cohort, which has collected roughly annual data on 3726 older adults with and without dementia since 2008. Data continued to be collected during the lockdowns, although by telephone and/or video call instead of in person. Individuals diagnosed with dementia at study entry were excluded from this study as were individuals with only one visit. Cognitive status was classified using the Clinical Dementia Rating (CDR) global score. Poisson regression with cubic splines to account for differences in age was used to compare the incidence of dementia before and after March 1st 2020.ResultsOut of 2242 individuals, 208 individuals developed dementia before and 50 developed dementia after 01/03/20. The incidence rate ratio of developing dementia after 01/03/20 was 0.847 (0.538–1.335) p = 0.570. In our secondary analysis we found that the positive association between mild cognitive impairment (MCI) and dementia incidence decreased after 1/3/20 (interaction effect p = 0.031).ConclusionThe incidence of dementia as defined using the CDR global score did not change significantly after the first lockdown began, but we found evidence that lockdown decreased the positive association between MCI and dementia incidence. This may reflect that individuals were progressing to dementia more rapidly and thus missing the MCI stage or that assessing patients over the phone made diagnosing MCI more challenging.

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“…Due to this targeted approach designed to give five equally-sized, matched groups, cohort composition is not representative of population prevalence of COVID-19 and long COVID. Further background details of cohort are reported elsewhere [23,30].…”

Section: Methodsmentioning

confidence: 99%

“…Given the known importance of such social determinants of health in other chronic conditions such type 2 diabetes, chronic obstructive pulmonary disease and cardiovascular disease [19–21], and the implications of ongoing COVID-19 symptoms on daily functioning [11], quality of life [8,22], cognitive impairment [23], and increased health risk [1,24], as well as socio-economic consequences such as ability to work [25,26], it is important to test whether relationships exist between recovery from COVID-19 and socio-demographic factors. In this study, our objective was to examine whether self-perceived recovery from COVID-19 was associated with: (1) measures of multiple social advantage and disadvantage derived on the basis of individuals’ positions within systems of social power and oppression [27]; and (2) individual socio-demographic factors (illustrated in our directed acyclic graph in Figure 1).…”

Section: Introductionmentioning

confidence: 99%

Social determinants of recovery from ongoing symptoms following COVID-19 in two UK longitudinal studies: a prospective cohort study

Cheetham,

Bowyer,

García

et al. 2023

Preprint

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BackgroundSocial gradients in COVID-19 exposure, illness severity, and mortality have been observed in multiple international contexts. Whether pre-existing social factors affect recovery from ongoing symptoms following COVID-19 and long COVID is less well understood.MethodsWe analysed data on self-perceived recovery following self-reported COVID-19 illness in two United Kingdom community-based cohorts, COVID Symptom Study Biobank (CSSB) (N = 2548) and TwinsUK (N = 1334). Composite variables quantifying socio-demographic advantage and disadvantage prior to the COVID-19 pandemic were generated from sex, ethnic group, education, local area deprivation and employment status. Associations between self-perceived recovery and composite variables were tested with multivariable logistic regression models weighted for inverse probability of study participation, adjusting for potential confounding by age, region and pre- pandemic health factors, and potential mediation by COVID-19 illness characteristics and adverse experiences during the pandemic. Further analyses tested associations between recovery and individual socio-demographic variables reflecting status prior to and during the COVID-19 pandemic.FindingsSocio-demographic gradients in recovery were observed, with unadjusted recovery rate varying between 50% and 80% in CSSB and 70% and 90% in TwinsUK based on composite socio-demographic variables. Likelihood of recovery was lower for individuals with more indicators of pre-pandemic social disadvantage in both cohorts (CSSB: odds ratio, OR = 0.74, 95% confidence interval, CI: 0.62-0.88, TwinsUK: OR = 0.79, 95% CI: 0.64-0.98 per disadvantage) and higher with more social advantages (CSSB: OR = 1.26, 95% CI: 1.08-1.47, TwinsUK: OR = 1.36, 95% CI: 1.09-1.70 per advantage). Associations were neither explained by differences in COVID-19 illness severity or timing, nor adverse social experiences during the pandemic, which were themselves inversely associated with recovery.InterpretationStrong social inequalities in the likelihood of recovery from COVID-19 were observed, with ongoing symptoms several months after coronavirus infection more likely for individuals with multiple indicators of social disadvantage. Work is needed to identify modifiable biopsychosocial factors to enable interventions that address inequalities.FundingChronic Disease Research Foundation, National Institute for Health and Care Research, Medical Research Council, Wellcome LEAP, Wellcome Trust, Engineering & Physical Sciences Research Council, Biotechnology and Biological Sciences Research Council, Versus Arthritis, European Commission, Zoe Ltd.Plain language summaryAcross the world acute COVID-19 illness has affected the most disadvantaged in society the most. However, we have not looked in detail whether people’s social circumstances affect their recovery from COVID-19. In our study, we asked people from two UK-based health studies if they still had symptoms after having COVID-19. We looked at how advantaged or disadvantaged they were at the start of the pandemic, based on information about their sex, ethnic group, education level, local area, and employment. In both studies, people who were more disadvantaged were more likely to still have symptoms long after having COVID-19. In contrast, more advantaged people were more likely to have fully recovered. We also saw that people who had negative experiences during the pandemic such as losing their job, being unable to afford their bills or not being able to access health & social care services were less likely to recover. More work is needed to understand how and why recovery was so different for people with different circumstances.Research in contextEvidence before this studyTo search for previous reports on associations between recovery from COVID-19 and socio-demographic factors, we screened abstracts identified from the PubMed search query on December 21, 2023: “((COVID-19) AND ((recovery) OR (convalescence) OR (“ ongoing symptoms”)) AND ((socioeconomic) OR (sociodemographic) OR (social) OR (gradient))) AND LitCLONGCOVID[filter]”, where LitCLONGCOVID is a filter for articles relating to long COVID (https://pubmed.ncbi.nlm.nih.gov/help/#covid19-article-filters), which returned 210 results published between July, 2020 and December, 2023.A small number (N = 11) of studies contained direct measures of recovery from COVID-19 in terms of presence/absence of ongoing symptoms relating to COVID-19 illness, either as perceived by the individual or inferred from current symptom reports. Of these, most focused on associations with COVID-19 illness factors such as severity and symptomatology, and prior health indicators. Socio-demographics were mostly used for sample description and adjustments in models rather than as exposures of interest. Of the few studies (N = 8) that tested associations with socio-demographic variables, the range of socio-demographics tested was limited and/or follow-up time typically restricted to 6-12 months since symptom onset. In these studies, associations with recovery were reported for age (N = 4), sex (N = 7), race/ethnicity (N = 2), local area deprivation (N = 1), and education level (N = 1). Associations between long-term symptoms and education or income have been reported in single separate studies. Monthly bulletins up to March 2023 from the UK Coronavirus Infection Survey highlighted prevalence of individuals reporting current effects on daily activities due to long COVID was associated with age, sex, race/ethnicity, local area deprivation and economic activity. No studies were identified that tested for associations of multiple socio-demographics in combination with the likelihood of recovery following COVID-19.Added value of this studyThis is the first study to testing the effects of multiple socio-demographics on self-perceived recovery in combination. Measures that attempt to quantify social advantage and disadvantage were generated from multiple known social determinants of health. We tested a wider range of socio-demographic factors than previous studies, including UK geographic region, educational qualification level, employment status and income. Our study has a longer follow-up time than previous comparable reports, with most participants assessed more than one year after infection onset. Detailed data on health before the coronavirus pandemic and COVID-19 illness allowed models to be adjusted extensively and mediation effects to be tested.Implications of all the available evidenceThe likelihood of full recovery following COVID-19 appears to follow a social gradient, higher for individuals with multiple indicators of social advantages and fewer disadvantages, and lower for those with multiple social disadvantages and fewer advantages prior to the coronavirus pandemic. This reflects and reaffirms the established cycle of social inequalities in health, between individuals’ status within social hierarchies and ill-health. More work is needed to understand the pathways through which this inequality operates so that interventions can be made.

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The effects of COVID-19 on cognitive performance in a community-based cohort: a COVID symptom study biobank prospective cohort study

Cited by 42 publications

References 46 publications

Long COVID is associated with severe cognitive slowing

Long COVID is associated with severe cognitive slowing

The risk of developing dementia in the COVID‐19 pandemic; a cohort study

Social determinants of recovery from ongoing symptoms following COVID-19 in two UK longitudinal studies: a prospective cohort study

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